Healthcare Provider Details

I. General information

NPI: 1467891606
Provider Name (Legal Business Name): STEFANIE GARDNER MEEK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 ALLYSON LN
CONWAY AR
72034-6281
US

IV. Provider business mailing address

PO BOX 11020
CONWAY AR
72034-0018
US

V. Phone/Fax

Practice location:
  • Phone: 501-730-0375
  • Fax:
Mailing address:
  • Phone: 501-581-3380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9668
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3944
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: